First Human Successful Re-Isolation of Pulmonary Veins Utilizing the Direct Endocardial Visualization Ablation Catheter for Recurrent Symptomatic Atrial Fibrillation

概要

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Gaps between radiofrequency (RF) ablation lesions are culprits for failed pulmonary vein isolation (PVI) leading to recurrent atrial fibrillation (AF). Recovery of electrical conduction across previously intact rings commonly warrants repeat isolation. We describe the first ever successful utilization of the Direct Endocardial Visualization (DEV) ablation catheter to re-isolate pulmonary veins by visually targeting inter-lesion gaps in human. A 60-year-old man presented with symptomatic AF following successful PVI 4 months prior. He had persistent debilitating symptoms despite multiple electrical cardioversions. Unfortunately, his symptoms recurred after initial PVI necessitating a repeat ablation. Double transeptal punctures were performed using Daig SL0 and Agilis sheaths. IRIS DEV ablation catheter was inserted via 14F sheath into the LA. NAVX fusion and activation mapping utilizing virtual electrograms were performed. Previous ring lesions appeared as whitish branched tissue. Pink inter-lesion gaps were localized with fractionated potentials and early activation timing adjacent to both intervenous ridges. Virtual saline electrode delivered RF lesions targeting both carina, successfully re-isolating all pulmonary veins. Patient reverted back to sinus rhythm during ablations. No peri-operative complication. Patient has remained symptom free off flecainide at 3-month follow up.